BLD2023-0399+PAPER PERMIT APPLICATION+3.31.2023_12.45.20_PM+3456306100
BUILDING PERMIT
APPLICATION
Development Services
Building Division
121 5th Ave N / Edmonds, WA 98020
425.771.0220
For handouts, submittal requirements go to: www.edmondswa.gov.
To apply for permits, schedule inspections, or check application status
go to: www.mybuildingpermit.com
JOB SITE INFORMATION/LOCATION: (Where the work is taking place)
Job Site Address: 650 Main St. Edmonds, WA 98020
Parcel: 00434209701100
Lot /Unit/Suite #: - Subdivision: 004342
BUSINESS OR PROPERTY OWNER:
Name: Sno-Isle Libraries
Mailing Address:
7312 35th Ave NE
City/State/Zip: Marysville, WA 98271
Phone #: (360) 651-7046
Email: rburley@sno-isle.org
OWNER INSTALLATION: *If yes, read and sign*
Will work be performed by the property owner? Yes �✓ No
I own, reside in, or will reside in the completed structure. This
installation is being made on property that I own which is not
intended for sale, lease, rent, or exchange according to RCW
18.27.090.
Owner Signature: -
APPLICANT / CONTACT INFORMATION:
Name of Applicant: Maggie Clacclo
Mailing address: 100 NE Northlake Way Suite 200
City/State/Zip: Seattle, WA 98105
Phone #: (208) 992-3695
E-mail: mciaccio@johnstonarchitects.com
GENERAL CONTRACTOR: (If different from applicant)
General Contractor: *TO BE PUBLICALLY BID*
Mailing Address:_
City/State/Zip: _
Phone #:
E-mail: -
STATE UBI #:
CITY OF EDMONDS BUSINESS LICENSE #: -
WA STATE CONTRACTOR L & I #: (CCB) & EXPIRATION DATE:
Office Use Only
TYPE OF PERMIT (Provide
Details on Page 2)
❑ Accessory Structure/
Addition
❑
Detached Garage
Demolition
Mechanical
New Single Family/Duplex
Plumbing
Fire Sprinkler
Remodel
New Commercial/Mixed Use
❑ Re -Roof
❑ Signs
Tank
❑ Tenant Improvement
❑ Other
Remodel Permit fees are based on:
The value of the work performed. Indicate the value (rounded to
the nearest dollar) of all equipment, materials, labor, overhead,
and the profit for the work indicated on this application.
Valuation: $2,000,000
PROPOSED.. FOR THIS APPLICATION
Basement scl ft: N/A Finished❑ Unfinished ❑
1st Floor, scl ft:
N/A
2nd Floor, scl ft:
N/A
Garage/Carport:, scl ft:
N/A
Deck/Covered Porch/Patio:
N/A
# of NEW Bedrooms: N/A # of NEW Bathrooms: N/A
PROJECT
THIS PROJECT IS A PROPOSED
RENOVATION OF AN EXISTING
16,726SF PUBLIC LIBRARY WITH
ASSOCIATED BUSINESS AREAS.
NO CHANGE IN OCCUPANCY OR
SQUARE FOOTAGE IS PROPOSED.
I certify that the information I have provided on this form/application is true,
correct and complete, and that I am the property owner or duly authorized
agent of the property owner to submit a permit application to the City of
Edmonds.
Print Name: Maggie Ciaccio
Margaret Ciaccio ° - -'°yam "�m 3/31 /2023
Signature: - Date
COMMERCIALGENERAL
Occupancy Group(s): A2, A3, B2 Occupant Load(s): 295
Type(s) of Construction: I I IA Fire Sprinklers: Yes❑ Noa
WA STATE ENERGY CODE: If your project affects the building envelope,
mechanical systems, and/or lighting, you must complete the
appropriate WSEC forms.
DEFERRED SUBMITTALS: All commercial building permits that will require
associated plumbing, mechanical, fire sprinkler, and/or fire alarm
permits are applied for separately.
TI / CHANGE OF USE / NEW BLDG: Include TRAFFIC IMPACT worksheet
EQUIPMENTMECHANICAL •
BTUs Gas / Elec / Other Qty
A/C Unit /Compressor
Air Handler /VAV
Boiler
Dryer Duct
Exhaust Fans
Fireplace
Furnace
Heat Pump Unit
Hydronic Heating
Roof Top Unit (Provide eleva-
tions if a Commercial Bldg)
Other:
COUNTSPLUMBING FIXTURE
Qty Qty
Clothes Washer
0
Tub/ Showers
0
Dishwasher
1
Backflow Device (RPBA, DCDA, AVB)
0
Drinking Fountain
0
Pressure Reduction/ Regulator Valve
0
Floor Drain/Sink
0
Refrigerator Water Supply
0
Hose Bibs
0
Water Heater - Tankless? Y or N
0
Hydronic Heat
0
Water Service Line
0
Sinks
2
Other:
0
Toilets
Other:
0
00UNTSGAS/FUIEL CONNECTION d or re piped)
BTUs Qty BTUs Qty
A/C Unit
Outdoor BBQ/ Fire pit
Boiler
Stove/Range/Oven
Dryer
Water Heater
Fireplace/ Insert
Other:
Furnace
Other:
COUNTSMEDICAL GAS, AIR VACUUM
Relocated or re piped)
Qty Qty
Carbon Dioxide
Nitrous Oxide
Helium
Oxygen
Medical Air
Other:
Medical - Surgical Vacuum
Other:
DEMOLITION
Type of structure to be demolished: N/A
Square footage of structure to be demolished: N/A
AHERA Survey done? Y❑/ N❑
PSCAA Case #: N/A
Critical Areas Determination:
Study Required ❑ Conditional Waiver ❑ Waiver❑
Fill in Place ❑ Fill Material: N/A
Removal ❑
Size of Tank (Gallons) N/A
Critical Areas Determination:
Study Required Conditional Waiver Waiver
GRADE/FILL/EXCAVATE
Grading: Cut N/A cubic yards
Fill N/A cubic yards
Cut / Fill in Critical Area: Yes ❑ No ❑
GENERAL PROVISIONS
APPLICATIONS: Applications are valid for a maximum of 1 year.
ESLHA Applications, 2 years.
LICENSING: All contractors and subcontractors are required to be licensed
with Washington State Department of Labor & Industries and have a
current City of Edmonds Business License.